The presence of Gleason 3 + 4 at biopsy, when compared to 3 + 3, increases the risk of adverse pathology being present at radical prostatectomy. When considering active surveillance (AS) as a primary treatment, a stricter protocol such as PRIAS, limiting PSA density and number of positive cores to ≤2, appears to decrease the risk of adverse pathology. No differences in biochemical cancer recurrence (BCR aka PSA only recurrence) were seen between biopsy 3 + 3 and 3 + 4 disease, regardless of AS when these additional factors are considered.
BJU international. 2016 Apr [Epub]
Lih-Ming Wong, Vincent Tang, Justin Peters, Anthony Costello, Niall Corcoran